P - 76127REQUEST FOR ELECTRICAL INSPECTION
1� 7 8 7� O 7 9 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electvicity.stade.mta.us
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� GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES Traffic Sianal Standard f�D �5
tAA, COMMUNICATION, REMOTE CONTROL,
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aoparatus (�a $.50
Unit
Fature
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1787079],
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Sf ns / Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Powrer Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweiling Unit @$BO
Additional Ins 'on Tri $20
Investigative Fee
Reinspection Fee @ $20
TOTAL FEE �(j, �Q
(minimum total fee is $20)
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I hereby cer6fy thet I inspeded the elutrical installatinn d�cribed herein on the detes stated:
DISCONNECTED IF NOT
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1'"'"'' Rough-in Inspection Required? ❑ Ye� � No Inspection Other Than Rough-In: [$Ready Now ❑ Wili Call
�014006
You must call the inspector when readyl Date Ready:
I c�rrtiiiy thet I am the [�J LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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